Djibouti City, Djibouti: Doctor Robert Thiel, an American volunteer from the Red Sea Mission, runs a government-owned clinic in Arhiba, a filthy slum in the port city of Djibouti. The clinic treats several hundred patients a day, despite having no budget and no running water.

"I don’t understand how people can still survive here," Thiel says. "Many people have worms - a consequence of extreme poverty. People defecate everywhere and worm eggs are carried hand to mouth."

One woman, clearly malnourished, sought help for her severely malnourished child. Thiel gave her 5000 Djibouti Francs for further treatment at the Peltier hospital downtown, which charges an admission fee of 2000 DF (11 $ US).

He gets support from friends abroad to help buy medicines and make cash handouts to those most in need.

"If I don’t give them money, they don’t even bother to go there," he said. "A significant proportion of the population cannot buy anything, no matter how cheap."

Dr. Mahdi Ali, head of paediatrics at the Peltier hospital, believes every third child in Djibouti is malnourished.

"In the slums, every second child is stunted. Many never make it to the health centres and die at home. That’s why it's very difficult to know infant mortality. In our hospital, 70 percent of all admitted children are malnourished, so are their mothers."

According to Ali, the hospital has neither the money nor the staff to properly attend to patients. "We can provide only about half of the health protocol necessary for malnourished children."

Dr. Ali would like the World Food Programme (WFP) to distribute more food aid in the slums.

"That’s out of the question" says Fatma Semoura, Resident Representative for WFP in Djibouti. "We can't do general distributions any more, it is simply too dangerous."

In the year 2000, WFP tried to distribute food to hungry slum dwellers. Military personnel were called in to quell riots when looting started at distribution centres.

WFP does provide Thiel’s clinic, however, with supplementary food for malnourished children. "But we reach only a few and don’t have food all the time," Thiel says.

This report does not necessarily reflect the views of the United Nations Office for the Coordination of Humanitarian Affairs.